College  of  3$f)p&imn&  anti  ^urgeonsi 
ICibrarp 


H2.IC    Nellie   n ' 

"^  I        SURGICAL   DRESSINGS   COMMITTEE 

National  Civic  Federation,  Woman's  Department,  New  England  Section 
Peter  Bent  Brigham  Hospital 

STANDARD 
SURGICAL   DRESSINGS 


BY 

NELLIE   A.  MACKENZIE,  R.  N 


PRICE,  30  CENTS  NET 


STANDARD 
SURGICAL  DRESSINGS 

DIRECTIONS  FOR   MAKING 


BY 

Nellie  A.   MacKenzie,  R.  N. 


SURGICAL   DRESSINGS   COMMITTEE 
Mrs.  Frederick  S.  Mead,  Chairman 

PETER   BENT    BRIGHAM   HOSPITAL 
BOSTON,  MASS. 

SURGEONS   ADVISORY   COMMITTEE 
Harvey  Gushing,  M.D. 
John  W.  Elliot,  M.D. 
Robert  B.  Greenough,  M.D. 
Charles  Allen  Porter,  M.D. 
Hugh  Williams,  M.D. 


SECOND    PRINTING 


WHITCOMB  &  BARROWS 
Boston,  191 6 


Copyright  1916 
By  Whitcomb  &  Barrows 


Thomas  Todd  Co.,  Pkinteks 
14  Beacon  Street,  Boston,  Mas; 


PREFATORY  NOTE 

The  contents  of  this  treatise  are  concise  and  accurate. 
Such  knowledge  is  indispensable  to  all  beginners  in  making 
dressings. 

It  may  be  useful  to  makers  of  dressings  to  know  in  a 
general  way  how  they  are  used.  Dry  dressings  are  com- 
monly used.  When  the  wound  is  closed  with  stitches  or 
otherwise  they  are  laid  on  the  surface,  and  usually  remain 
undisturbed  until  the  wound  is  healed. 

When  a  wound  is  open  and  infective  the  soft,  elastic, 
absorbent  sterile  gauze  is  packed  in  so  that  it  comes  in  con- 
tact with  the  whole  wound  surface,  leaving  no  pockets  where 
discharge  might  collect.  Such  dressings  are  changed  at 
periods  varying  according  to  the  condition  of  the  patient 
and  the  amount  of  discharge.  Continued  use  of  sterile  gauze 
on  an  infected  wound  tends  to  clean  the  wound  and  stop  the 
infection,  the  gauze  mesh  having  a  stimulating  effect  on  the 
granulations.  As  the  wound  becomes  healthy,  less  and  less 
gauze  is  packed  in  until  finally  the  wound  closes. 

Wet  dressings  are  sometimes  used,  in  which  case  they 
are  changed  often  to  keep  them  moist  and  clean.  When  a 
wound  is  gangrenous  and  foul,  or  faecal  with  a  great  amount 
of  discharge,  oakum  dressings  are  useful,  because  they  ab- 
sorb and  deodorize  the  discharge.  Sphagnum  moss  is  also 
used  in  such  cases. 

John  W.  Elliot,  M.D., 
Chairman  of  Surgeons  Advisory  Committee. 

Boston,  September,  1916. 


Digitized  by  tine  Internet  Arciiive 

in  2010  witii  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/standardsurgicalOOmack 


INTRODUCTION 

In  the  making  of  surgical  dressings  for  war  relief, 
changes  were  imperative  from  the  ordinary  methods  of 
preparation  and  storage.  In  hospitals,  dressings  are  ordi- 
narily used  within  a  few  days ;  for  European  war  relief, 
an  ocean  journey  of  over  three  thousand  miles  involves 
handling  from  six  to  eight  times  before  use,  and  it  was 
found  that  sterilization  could  not  be  insured  for  any  length 
of  time  unless  the  dressings  were  wrapped  in  air-proof 
paper  and  sealed  in  tins.  Many  details  in  the  methods  of 
making,  and  especially  of  wrapping  and  packing,  were 
worked  out  by  the  committee,  by  the  advisory  surgeons,  and 
by  the  help  of  surgeons  returned  from  the  front. 

When  I  began  to  teach  the  making  of  surgical  dressings 
in  connection  with  this  work,  I  very  soon  felt  the  need  for 
authoritative  descriptions  of  the  different  dressings  and  for 
a  simple  account  of  the  ways  in  which  they  are  used ;  in  other 
words,  a  text-book  was  needed  for  my  classes,  and  I  was 
surprised  to  find  that  practically  nothing  of  the  kind  has 
ever  been  written.  This  little  treatise  has  been  prepared 
under  pressure  of  work,  and  it  is  intended  only  to  meet  the 
present  need.  After  the  war  is  over  I  hope  to  make  a  revi- 
sion that  shall  be  more  worthy  of  the  scientific  subject  it  is 
my  ambition  to  explain.  It  is  a  subject  that  should  be  in- 
cluded in  the  course  of  study  of  every  nurse  and  surgeon. 
Besides  following  these  descriptions  literally,  it  is  advisable 
in  class  work  to  have  a  graduate  nurse  as  instructor.  The 
perfectly  made  and  thoroughly  sterilized  dressing  which  is 

5 


6  STANDARD    SURGICAL    DRESSINGS 

the  safe  product   will  probably  be  made  only  under  such 
direction. 

Speaking  generally,  the  term  "surgical  dressings"  is 
given  to  all  materials  and  appliances  used  for  dressing  or 
protecting  wounds.  Such  appliances  as  splints,  frames,  etc., 
are  important  surgical  dressings,  but  they  are  not  included 
here. 

Nellie  A.  MacKenzie. 


CONTENTS 

Chapter  I.  The  Materials  to  Use  for  Making  and  Pack- 
ing Surgical  Dressings. 

Chapter  II.  Important  Points  to  be  Considered  in  Making 
Surgical  Dressings. 

Chapter  III.  How  to  Make  Dressings  that  will  be  Used 
Sterile — Sponges,  Compresses,  Pads,  Drains,  Gauze 
Rolls,  Meter  Gauze. 

Chapter  IV.  How  to  Make  Dressings  that  will  be  Used 
Non-Sterile — Abdominal  Bandages,  T  Bandages,  Tri- 
angular Bandages,  Muslin  Bandages,  Sheet  Wadding 
Bandages,  Crinoline  Bandages,  Head  Bandages,  Scul- 
tetus  Bandages. 

Chapter  V.   How  to  Make  Dressings  into  Packages. 

Chapter  VI.  How  and  Why  Surgical  Dressings  are 
Sterilized. 

Chapter  VII.  Preparation  of  Dressings  for  Storage  and 
Shipment. 


CHAPTER  I 

The  Materials  to  Use  for  Making  and  Packing  Surgical 
Dressings 

Surgical  or  hospital  gauze  forms  the  largest  part  of 
surgical  dressings.  It  is  chosen  because  of  its  particular 
weave  and  texture,  its  elasticity  and  its  softness.  These 
qualities  render  it  absorbent.  Gauze  that  is  very  soft  and 
free  from  sizing  is  more  absorbent  and  of  greater  value  to 
the  surgeon,  although  it  is  more  difficult  to  cut  and  fold. 
There  are  several  grades  of  gauze  in  the  market,  and  the 
grade  is  marked  according  to  the  number  of  threads  woven 
in  the  sc^uare  inch.  The  following  table  gives  the  grades  of 
gauze  and  the  number  of  threads  they  contain : 

Gauze  No.  3A     has  20  x  12  threads  to  the  square  inch. 

"      No.  3  "    20  X  14 

"      No.  2 A       "    20x16 

"      No.  2AA    "    22  X  18 

"      No.  2  "    24  X  20 

"      No.  I A       "    28  X  24 

"      No.  I  "    32  X  24 

After  this  it  is  not  numbered  and  is  too  heavy  to  use  for 
dressings,  but  is  desirable  for  gauze  bandages. 

All  gauze  is  woven  one  yard  wide,  and  usually  one  hun- 
dred yards  in  a  piece.  It  can  be  obtained  in  flat  fold,  which 
means  the  entire  length  is  folded  back  and  forth  in  one- 
yard  turns,  or  in  double  fold,  which  means  that  it  is  doubled 
lengthwise  through  the  middle  and  rolled  on  cardboard. 
This  grade  is  also  spoken  of  as  booked,  rolled,  or  bolted 

9 


10  STANDARD    SURGICAL   DRESSINGS 

gauze.  INIanufacturers  will  cut  gauze  to  any  desired  size  for 
dressings,  but  by  doing  it  for  yourself  you  save  expense, 
which  is  considerable,  and  at  the  same  time  develop  your 
own  skill. 

From  the  cotton  plant  we  get  absorbent  cotton.  The  raw 
cotton  contains  oil,  and  in  order  to  make  it  absorbent  this 
oil  must  be  removed.  To  do  this  the  cotton  is  soaked  in 
caustic  soda  and  then  thoroughly  washed.  This  process  not 
only  removes  the  oil  but  makes  the  cotton  soft  and  white. 
There  are  several  grades  of  absorbent  cotton,  that  having 
the  longest  fiber  being  the  most  valuable.  The  finer  quality 
is  used  for  pledgets  or  wipes  for  surgery  of  the  eye,  nose, 
and  ear.  The  coarser  grades  are  used  in  making  pads  for 
dressings  where  there  is  a  discharge  to  be  absorbed.  The 
very  finest  grade  of  absorbent  cotton  is  known  as  jewelers' 
cotton,  and  is  used  to  pack  about  jewelry  and  silverware. 

Sheet  wadding  also  comes  from  the  cotton  plant.  The 
cotton  is  pressed  into  thin  sheets  and  then  sized,  which  ren- 
ders it  tough  and  non-absorbent.  It  is  used  for  the  padding 
of  splints,  and  also  is  made  into  cotton  wadding  bandages. 
These  bandages  are  used  over  dressings  before  the  ordinary 
cotton  or  gauze  bandage  is  applied. 

Oakum  originally  came  from  ropes  and  cordage  that  had 
been  used  about  the  decks  of  ships  and  were  saturated  with 
tar.  After  these  ropes  became  frayed  and  were  of  no  more 
use  as  such,  they  were  picked  apart  and  the  strands,  or 
oakum,  as  it  was  called,  were  used  for  the  calking  of  the 
leaking  seams  of  the  ship.  The  work  of  picking  the  ropes 
apart  was  given  to  convicts  as  a  penal  service,  each  being 
obliged  to  pick  a  certain  amount  a  day.  Much  of  the  oakum 
used  at  present  is  made  from  the  waste  ends  of  hemp  and 


STANDARD    SURGICAL   DRESSINGS  II 

jute  left  from  the  manufacture  of  rope.  This  waste  is  sat- 
urated with  pine  tar  and  makes  a  vakiable  surgical  dressing. 
It  is  absorbent,  antiseptic,  and  deodorant,  and  when  made 
into  pads  is  used  on  foul-discharging  and  gangrenous 
wounds. 

Sphagnum  moss,  also  known  as  peat  moss,  or  turf,  is  a 
plant  found  in  the  woods,  especially  in  the  wet  sections.  It 
is  very  valuable  as  a  surgical  dressing  because  of  its  ab- 
sorbent properties.  It  will  absorb  tenfold  its  weight  of  fluid, 
while  cotton  will  absorb  but  sixfold  its  weight.  It  is  inex- 
pensive and  can  be  obtained  at  any  florist's. 

Unbleached  muslin  for  bandages  may  be  of  any  texture 
that  can  be  torn  and  rolled  neatly.  Gauze  bandages  are 
much  used,  but  are  very  difficult  to  tear  and  roll  because  of 
the  thin  texture  of  the  gauze. 

Unbleached  cotton  used  for  covering  sterile  dressings 
must  be  of  a  heavy,  closely  woven  material,  so  that  dust  can- 
not easily  penetrate  through  its  meshes  and  carry  with  it 
germs  which  render  the  dressings  unsterile.  Filter  paper 
and  a  heavy,  tough  quality  of  brown  paper  are  also  used  for 
the  covering  of  sterile  dressings. 

Cotton  flannel  and  domet  flannel,  as  well  as  unbleached 
cotton,  are  used  for  abdominal  binders.  Unbleached  cotton, 
firm  and  of  medium  weight,  is  used  for  triangular  bandages 
or  slings. 

Safety  pins.  No.  2-|,  and  dressmakers'  pins.  No.  5,  are 
the  most  convenient  size  for  general  use. 

Scissors  eight  inches  long  and  of  medium  weight  can  be 
used  for  all  ordinary  cutting. 


CHAPTER  11 

Important  Points  to  be  Considered  in  Making  Surgical 
Dressings 

Because  surgical  dressings  are  such  an  important  part 
of  the  surgeon's  equipment,  we  should  aim  to  be  accurate, 
neat,  clean  as  to  person  and  appliances  used  in  connection 
with  their  making,  careful  in  every  detail,  however  unimpor- 
tant it  may  seem,  and  the  mind  should  always  be  on  the 
work.  A  room  should  be  set  apart  for  this  work,  and  sliould 
be  kept  as  free  from  dust  as  possible.  The  table  on  which 
dressing's  are  folded,  if  made  of  wood,  should  be  covered 
with  enamel  cloth,  a  gray  color  being  preferred  to  white  as 
less  trying  to  the  eyes  in  the  glare  of  light. 

Pins  must  never  be  allowed  to  lie  about  loose  on  the 
tables,  as  they  easily  become  caught  in  the  meshes  of  the 
gauze,  and  might  be  carried  away  in  the  dressings  and 
finally  be  lodged  in  an  open  wound. 

All  folding  should  be  done  accurately,  and  for  dress- 
ings that  will  be  used  in  open  wounds  all  raw  edges  must  be 
carefully  turned  in. 

The  counting  of  dressings  that  are  to  be  used  in  the  ab- 
dominal or  other  deep  cavity  is  most  important,  and  this 
couiU  sliould  always  be  verified  by  a  second  person.  If  ten 
dressings  are  supposed  to  be  in  a  package  and  there  are 
onl\-  nine,  the  jjatient  may  be  kept  under  ether  with  danger 
to  the  heart  while  the  tenth  and  missing  one  is  being  sought 
for.  1  f  eleven  dressings  are  in  the  parcel,  one  may  be  left  in 
the  wound,  the   wound  closed,  and  the  mistake  not  discov- 


STANDARD    SURGICAL   DRESSINGS  1 3 

ered  until  general  disturbances  in  the  patient's  condition 
arouse  suspicion.  This  mistake  has  occasionally  made  neces- 
sary a  second  operation. 


CHAPTER  III 

How  to  Make  Dressings  that  will  be  Used  Sterile 

Sponges,    Compresses,   Pads,    Drains,    Gauze   Rolls,    Meter 
Gauze 

All  dressings  that  come  in  direct  contact  with  wounds 
must  be  sterilized  before  they  are  used. 

Sponge  No.  1.   Directions  for  Cutting 

Sponges  may  be  cut  from  either  the  flat- fold  or  double- 
fold  gauze.  If  the  double-fold  gauze  is  used,  it  is  necessary 
to  roll  it  on  a  board  twelve  inches  wide.  The  board  should 
be  thin,  as  otherwise  the  size  of  the  outer  layers  of  gauze 
would  be  greater  than  of  the  inner  layers.  Begin  to  roll  with 
the  end  of  the  gauze  at  the  middle  of  the  flat  side  of  the 
board.  After  about  twenty  full  turns  have  been  made,  make 
a  cut  down  the  middle  of  the  flat  side  of  the  roll,  from  sel- 
vage to  fold,  on  the  same  side  on  which  you  began  to  roll. 
This  makes  twenty  pieces  of  gauze  measuring  i8  x  24 
inches,  double  thickness.  Cut  these  again  through  the  mid- 
dle from  selvage  to  fold,  obtaining  the  desired  size  for 
sponges,  12x18  inches,  double  thickness.  Sponges  cut  from 
double- fold  gauze  are  more  accurate  in  size  and  freer  from 
loose  threads  than  those  cut  from  flat-fold  gauze,  but  it 
takes  longer  to  cut  them.  In  cutting  flat- fold  gauze  for 
sponges,  arrange  the  entire  piece  of  gauze  on  the  table  as 
straight  as  possible ;  find  center  of  selvage  edges,  lay  yard- 
stick across  and  crease  with  scissors,  cut  through  crease 
from  selvage  to  selvage,  and  this  will  give  two  parts  meas- 
uring   18x36  indies.    Each  of  these  pieces  may  be  cut  in 

14 


STANDARD    SURGICAL   DRESSINGS 


15 


thirds,  making  in  all  six  pieces  measuring  12  x   18  inches, 
double  thickness.   See  diagram  : 


Fold  36' 


Chart  for  Cutting  Sponge  No.  1 
Cut  Cut 


12x18 


12x18 


12x18 


36' 


12x18 


12x18 


12x18 


Fold  36" 
Directions  for  Folding  Sponge  No.  1 

Spread  one  double  thickness  of  gauze  measuring  12x18 
inches  on  table,  remove  all  loose  threads,  turn  in  raw  edges 
opposite  fold  i  inch,  turn  in  all  corners,  fold  each  remain- 
ing raw  edge  to  center,  fold  again,  edge  to  edge.  Now  fold 
from  ends  to  center.  Fold  once  more,  making  the  complete 
sponge  3x4!  inches. 

Sponge  No.  2.    Directions  for  Cutting 

Arrange  entire  piece  of  flat-fold  gauze  on  table.  Cut  off 
entire    strip   of    gauze   along   one    selvage   4   inches    wide. 


i6 


STANDARD    SURGICAL   DRESSINGS 


This  Strip  will  later  be  used  to  make  drains.  This  cutting 
leaves  a  piece  of  gauze  measuring  32  x  36  inches.  Divide 
this  lengthwise  through  middle,  making  two  pieces  meas- 
uring 16  X  36  inches.  Each  of  these  is  divided  into  parts 
measuring  12  x  16  inches,  single  thickness,  which  is  the 
required  size  for  sponges.  If  the  36  inches  were  divided 
into  three  12-inch  pieces,  the  cutting  of  the  fold  on  the  outer 
ends  would  make  these  two  pieces  under  size ;  consequently 
the  cutting  represented  in  the  chart  is  better.  The  two  inside 
pieces  measure  12  inches  single,  while  the  two  outside  pieces 
measure  6  inches  double. 
See  diagram : 

Chart  for  Cutting  Sponge  No.  2 

36"  fold  4" 


^                      16" 
1                12  X  16 

CO 

16" 
12  X  16 

c 
Q 

a> 

> 

1,                 12x16 

12x16 

|q                12  X  16 

12x16 

4> 

3 

§                 12  X  16 

^                   16" 

12  X  16 
16" 

36"  fold 


STANDARD    SURGICAL    DRESSINGS  I7 

Directions  for  Folding  Sponge  No.  2 

Place  single  thickness  of  gauze  measuring-  12x16  inches 
on  table,  the  shorter  edge  towards  you.  Fold  the  two  shorter 
edges  together,  then  fold  again  in  the  same  direction,  mak- 
ing strip  4x12  inches.  Fold  this  again  into  thirds,  making 
a  square  measuring  4  inches.  This  sponge  is  now  turned 
in  the  following  way  in  order  to  secure  all  loose  threads 
and  raw  edges.  Place  thumbs  inside  the  pocket  (which  is 
formed  in  the  folding),  with  one  thickness  of  gauze  above 


"PLACK    THUMBS    INSIHE    THE    POCKET" 

and  eleven  thicknesses  below.  Hold  sponge  firmly  and  turn 
inside  out,  being  sure  to  keep  the  corners  square.  This  turn- 
ing forms  another  pocket,  with  two  thicknesses  of  gauze 
above  and  ten  thicknesses  below.  Place  thumbs  in  this 
pocket,  hold  firmly  in  hands,  and  turn  as  before,  keeping 
corners  square.  This  completely  covers  all  raw  edges  and 
makes  the  sponge  safely  and  securely  folded  together. 

This  sponge  is  also  cut  6x8  inches,  and  is  folded  in  the 
same  way,  to  measure  2x2  inches  when  completed. 


i8 


STANDARD    SURGICAL    DRESSINGS 


.  '*  t-'^i*.-  «*.  ^t  iLi-'~-siGSl^3>>. 


THE    COMPLETED   TURN 


The  primary  use  of  a  sponge  is  a  wipe.  Sponge  No.  2 
can  be  used  only  for  a  wipe,  while  sponge  No.  i  may  be 
used  as  a  wipe  or  a  drain,  or  may  be  shaken  out  for  a 
dressing. 


Compresses 

These  are  made  from  a  single  thickness  of  gauze  and  of 
various  sizes.  They  are  not  used  in  wounds,  but  as  outside 
dressings.  A  compress  cut  6x  12  inches  will  measure  3x3 
inches  when  folded.  One  cut  18  x  36  inches  will  measure 
9x9  inches  when  folded.  The  most  practical  size  for  gen- 
eral use  is  cut  10  x  20  inches  and  folded  to  measure  5  x  5 
inches. 

The  two  diagrams  following  show  methods  of  cutting 
compresses  from  entire  piece  of  flat-fold  gauze: 


STANDARD    SURGICAL   DRESSINGS 

Chart  for  Cutting  Gauze  Compresses 
36"  fold 


19 


18" 

3 

1                 18  X  36 

tH 

18" 
18  X  36 

_1) 

3 

^                 18  X  86 

00 
1—1 

18" 

18  X  36 
18" 

86"  fold 

To  Fold  a  Compress 

Place  single  thickness  of  gauze  of  the  desired  size  on 
table  with  longer  edge  towards  you.  Fold  long  edges  to 
middle,  turn  small  corners,  and  fold  ends  to  middle.  Then 
fold  once  more,  making  a  square  of  gauze  having  eight 
thicknesses.  , 

Wicks  or  Drains 

These  are  used  in  septic  wounds  to  keep  them  open  that 
they  may  drain  properly  and  heal  from  the  bottom.  Wicks 
may  be  made  from   i   to  3  yards  long  and  from  ^  inch  to 


20 


STANDARD    SURGICAL   DRESSINGS 


Chart  for  Cutting  Gauze  Compresses  and  Cut  Gauze 
Folded  edge  36"     3d  Cut  4th  Cut 


14"  double 

14"  double 

5            Compress 
Z            14  X  28 

Compress 
14x28 

;  CutGauze 

7x8 

:  CutGauze 

7x8 

6"              6" 

en                    tn 

(U                    <u 

V               en                    u3 

i.^     (M    tn      :       <M    tn 

">*      1— 1    <U                1— 1    (U 

tH           ^h      :             ^ 

X    O,     :        X    ft 

«D    g             --0    S 

O                    O 

O     ;         O 

6" 

1— 1 

6" 

1— 1 

6"               6" 

.        10  X  20 
g  Compresses 

10"  double 

10x20 
Compresses 

10  X 
Compr 

20         , 

esses    : 

10x6     ^ 
[CutGauze'-' 

u 


u 


o 


Fol'd  edge  36"  5th  Cut 


6th  Cut 


7th  Cut 


3  inches  wide.  They  should  be  cut  along  a  drawn  thread 
and  folded  so  that  it  is  not  possible  for  any  loose  threads 
to  get  into  the  wound.  The  wider  drains  may  be  cut  across 
the  gauze  from  selvage  to  selvage,  which  will  make  them 
T  yard  long  and  give  a  safe,  firm  selvage  end.  Where  a 
longer  drain  is  to  be  made,  it  is  necessary  to  cut  lengthwise 
of  the  gauze,  and  this  gives  raw  edges  on  the  ends.  When 
folding  these,  the  ends  -must  be  turned  down  at  least  i  inch. 
Then  turn  small  corners  and  fold  the  long  edges  of  the 
gauze  to  the  middle,  leaving  just  space  enough  for  a 
"hinge."    Then    turn   the    folded    edges  together   and    roll. 


STANDARD    SURGICAL    DRESSINGS  21 

Each  drain,  after  being  rolled,  should  be  tied  with  a  small 
thread. 

Gauze  Rolls 

These  rolls  are  used  for  packing  wounds.  They  should 
be  cut  along  a  drawn  thread,  and  the  same  care  should  be 
used  as  in  making  a  drain ;  that  is,  to  turn  in  all  ends  and 
corners  and  remove  all  lint.  They  are  cut  i8  inches  wide 
and  from  i  to  3  yards  long.  They  are  made  from  either 
sinarle  or  double  thickness  of  gauze. 


GAUZE    ROLLS 

To  Fold  Gauze  Rolls 

Turn  all  corners,  also  at  least  2  inches  on  each  end. 
Then  fold  the  long  edges  to  middle  and  fold  again,  making 
a  long  strip  of  gauze  about  4  inches  wide.  This  is  then 
rolled  and  tied  with  a  thread  loosely  so  that  it  is  in  correct 
shape  for  use. 

Meter  Gauze 

This  is  called  also  handkerchief  gauze  or  accordion 
plaited  gauze.  It  is  used  as  a  wipe,  as  a  packing  for  wounds, 
and  also  is  shaken  out  for  a  dressing.  It  is  virtually  a  large 
sponge.  It  should  be  cut  along  a  drawn  thread  and  be  36 
inches  wide  and  40  inches  long. 


22  STANDARD    SURGICAL   DRESSINGS 

To  Fold  Meter  Gauze 

Place  the  required  length  of  gauze  on  the  table  with  the 
selvage  at  right  and  left,  respectively,  and  a  raw  edge 
towards  you.  Turn  in  the  corners  about  2  inches,  then 
fold  the  raw  edge  at  least  2  inches.  Then  make  a  second 
turn,  4  inches  wide.  These  two  turns  are  to  be  firmly 
pressed  down,  as  they  form  the  foundation  on  which  the 
remaining  length  of  gauze  is  accordion  plaited  back  and 
forth.  The  other  raw  end  is  folded  in  the  same  way  as  the 
first.  This  plaiting  makes  a  strip  measuring  4  inches  wide 
by  36  inches  long.  This  is  again  accordion  plaited  on  itself 
to  5-|  inches,  making  the  finished  gauze  measure  4  inches 
wide  by  5^  inches  long. 

Cut  Gauze       (See  Diagram  on  page  20 ) 

This  consists  of  odd  lengths  of  gauze,  left  over  from 
cutting  the  larger  dressings.  It  is  used  as  a  first-aid  dress- 
ing, and  may  be  used  either  wet  or  dry,  as  a  wipe  or  as  a 
dressing  on  superficial  wounds.  It  is  cut  in  various  sizes 
from  4x4  inches  up  to  7x10  inches  or  larger.  Almost 
any  small  piece  of  gauze  may  be  used  for  this  dressing. 
The  raw  edges  do  not  need  to  be  turned  in.  These  dress- 
ings are  folded  to  approximately  4x4  inches. 

Cotton  Pads 

These  are  used  to  absorb  discharges.  They  are  made  of 
absorbent  cotton,  and  may  be  made  thick  or  thin,  according 
to  the  wound  on  which  they  are  to  be  used.  From  one  pound 
of  absorbent  cotton  ten  medium-sized  pads,  measuring 
8x11  inches,  may  be  cut. 


STANDARD    SURGICAL    DRESSINGS  23 

To  make  a  cotton  pad,  place  on  the  table  a  piece  of  gauze 
measuring  18x36  inches.  On  this,  6  inches  from  one  end 
and  in  the  middle,  place  a  piece  of  sheet  wadding  of  double 
thickness,  8x11  inches.  Over  this  place  absorbent  cotton, 
8x11  inches,  and  of  the  thickness  desired  for  the  pad.  Fold 
the  shorter  end  of  gauze  neatly  up  over  the  absorbent  cot- 
ton, then  the  sides  up  over  the  edges.  Draw  the  longer  end 
up  and  tuck  in  pocket  formed  at  opposite  end.  Roll  from 
the  pocket  end  with  sheet  wadding  on  back. 

Oakum  Pads 

These  are  used  to  absorb  discharges  and  are  especially 
valuable  if  the  wound  is  foul  and  gangrenous.  To  make  an 
Ij^^^  oakum  pad,  place  on  the  table  a  piece  of  gauze  measuring 
18  X  36  inches.  On  this,  in  the  middle  and  6  inches  from 
one  end,  place  a  piece  of  washed  cloth  or  cotton  wadding 
measuring  8x11  inches,  double  thickness.  On  this  place 
finely  picked  oakum  to  the  thickness  of  i  inch.  Over  this 
place  a  double  thickness  of  gauze  measuring  12x18  inches. 
Tuck  in  the  edges  between  the  oakum  and  cotton  cloth. 
Draw  up  the  end  of  the  first  piece  of  gauze  over  the  end 
of  the  pad,  then  the  sides,  and  finish  in  the  same  manner  as 
with  the  cotton  pad. 

Sphagnum  Moss  Pads 

These  are  used  to  absorb  discharges,  and  are  lighter  and 
more  absorbent  than  the  cotton  pads.  To  make  a  moss  pad, 
make  a  bag  of  old  cotton  (or  of  new  cotton  that  has  been 
washed  at  least  once)  to  measure  8x11  inches.  Pick 
sphagnum  moss,  being  careful  to  remove  all  sticks  and 
leaves,  and  place  it  in  the  bag,  making  it  flat  and  even  like  a 
poultice.    It  should  be  at  least  i  inch  thick.    On  the  back  of 


24 


STANDARD    SURGICAL    DRESSINGS 


the  bag  place  a  piece  of  cotton  wadding  8  x  ii  inches,  dou- 
ble thickness,  and  fold  the  entire  pad  in  a  single  piece  of 
ganze  measuring  18x36  inches.  Finish  in  the  same  way  as 
with  the  cotton  pad. 

Gauze  Laparotomy  Pads  with  Tapes 

These  pads  are  made  in  three  sizes  and  are  used  in  ab- 
dominal surgery.  A  long  loop  of  tape  is  sewed  on  one  end 
of  each  pad  in  order  to  lessen  the  danger  of  their  being  left 
in  the  abdominal  cavity.  A  pad  measuring  12  x  12  inches 
hnished  must  be  cut  24  x  36  inches. 

See  diagram : 

Chart  for  Cutting  Gauze  Laparotomy  Pad 
Cut  24  X  36"     Fold  12  x  12" 

36"  fold 


V 

. 

^ 

0 
t3 

24x36 

(N 

-H 

Tt< 

24  X  30 

c« 

36"  fold 


STANDARD    SURGICAL   DRESSINGS 


25 


Directions  for  Folding  12  x  12  Pad 

Place  on  the  table  a  single  thickness  of  gauze  measuring 
24  X  36  inches,  with  the  longer  edge  towards  you  and  the 
selvage  edges  at  your  right  and  left,  respectively.  Fold  the 
two  longer  edges  to  meet  in  the  middle,  then  fold  one  sel- 
vage edge  up  12  inches.  Over  this  fold  the  remaining  selvage 
edge,  making  a  square  12x12  inches  and  having  six  thick- 
nesses of  gauze.  This  is  now  sewed  all  around  the  edges 
(being  careful  to  catch  in  all  the  folds)  and  also  diagonally 
from  corner  to  corner,  crossing  in  the  center.  A  loop  of 
tape  16  inches  long  is  securely  sewed  on  one  corner,  being 
sure  that  no  raw  edge  of  the  tape  is  left  exposed. 

A- pad  measuring  6  x  6"  finished  is  cut  18  x  18". 

.Chart  for  Cutting  Laparotomy^Pad     Cut  18  x  18"     Fold  6  x  6" 
36"  fold 


18" 

0      18  X  18 

0-. 

18" 
18x18 

^      18x18 

18  X  18 

1      18  X  18 

cr. 

18" 

18  X  18 

18" 

36"  fold 


26 


STANDARD    SURGICAL    DRESSINGS 


Directions  for  Folding  6x6  Laparotomy  Pad 

Place  on  talkie  a  piece  of  gauze  measuring-  i8  x  i8  inclies. 
Fold  over  the  raw  edge  at  right  angles  to  the  selvage  edge 
I  inch.  Then  fold  over  the  raw  edge  opposite  the  selvage 
edge  6  inches.  Then  fold  remaining  6  inches  over  this, 
making  a  strip  of  gauze  measuring  6xi8  inches.  Fold 
this  strip  in  thirds,  being  sure  to  have  the  raw  end  folded 
inside.  This  gives  a  pad  6  inches  square  and  having  nine 
thicknesses  of  gauze.  Sew  edges  all  the  way  around,  being 
careful  to  catch  in  all  the  folds,  and  also  sew  diagonally 
from  corner  to  corner,  crossing  in  the  center.  A  loop  of 
tape  1 6  inches  long  is  securely  sewed  on  one  corner. 

A  pad  measuring  4  x  16"  finished  is  cut  16  x  32". 

Chart  for  Cutting  Laparotomy  Pads,  Gauze  Wipes,  and  Drains 
Cut  16  X  32"     Fold  4  x  16" 


36"  fold 


4" 


■ji 

16" 

16" 

(M 

CO 

CO 

Sponges 
0x8               0x8 

0x8                0x8 

80"  fold 


STANDARD    SURGICAL   DRESSINGS  2/ 

To  fold  this  pad,  place  a  single  thickness  of  gauze  on 
table  with  longer  edge  towards  yon.  Fold  the  shorter  ends 
to  the  middle,  then  fold  remaining  raw  edges  to  the  middle. 
Then  fold  once  more,  making  a  pad  measuring  4x16 
inches.  This  is  sewed  all  around  edges,  being  sure  to  catch 
in  all  the  folds.  A  loop  of  tape  16  inches  long  is  securely 
sewed  on  one  corner. 


CHAPTER  IV 

How  to  Make  Dressings  that  will  be  Used  Non-Sterile 
Abdominal  Bandages,  T  Bandages,  Triangular  Bandages, 
Muslin  Bandages,  Sheet  Wadding  Bandages,  Head  Band- 
ages, Scultetus  Bandages 

These  dressings  do  not  come  in  direct  contact  with 
\\'onnds ;  therefore  they  are  used  non-sterile. 

Bandages 

These  are  used  over  dressings  to  keep  them  in  place  and 
are  also  applied  tightly  to  limbs  to  reduce  swelling.  They 
can  be  made  of  unbleached  muslin,  cotton  flannel,  or  flannel. 
Any  muslin  that  will  tear  and  roll. neatly  may  be  used  for 
bandages.  They  are  made  from  2  to  8  inches  wide  and  from 
6  to  8  yards  long.  A  wide  bandage  after  being  rolled  may 
be  cut  to  any  width  with  a  sharp  knife.  For  general  use 
4  inches  is  a  convenient  width.  After  bandage  material  is 
torn  in  strips  of  correct  width,  it  should  be  straightened  and 
rolled  on  a  bandage  roller.  Remove  ravelings,  miter  the 
corners,  and  fasten  with  a  common  pin.  Then  place  a  safety 
pin  in  the  miter  in  such  a  manner  that  it  may  be  easily 
removed  when  needed  by  the  surgeon. 

Canton  flannel  and  flannel  bandages  are  best  cut  on  the 
l)ias.  A  muslin  bandage  made  of  a  heavy  grade  of  mate- 
rial and  cut  on  the  bias  is  very  elastic,  and  mav  be  used  in 
place  of  the  Uender  bandage.  * 

Triangular  Bandages  or  Slings 

These  should  be  made  of  a  heavy  grade  of  muslin.  Cut 
a  square  of  nmslin  36  to  40  inches  on  the  side.    Fold  diag- 

28 


STANDARD    SURGICAL   DRESSINGS  29 

onally  and  cut  along  the  fold,  making  two  triangular  band- 
ages. Hem  the  raw  edges,  fold,  and  place  two  safety  pins 
in  each. 

Abdominal  Bandages 

These  are  used  to  keep  dressings  in  place,  and  may  be 
made  of  muslin,  cotton  flannel,  or  domet  flannel.  If  made 
of  muslin  they  should  be  double  thickness,  the  edges  all 
turned  in  and  stitched.  If  made  of  cotton  flannel  or  domet 
flannel,  the  selvage  must  be  removed  and  the  edges  overcast 
or  finished  with  a  narrow,  flat  hem.  They  are  cut  15  inches 
wide  and  from  54  to  60  inches  long.  Two  straps,  3  inches 
wide  and  30  inches  long,  should  be  supplied  with  each  band- 
age, as  they  are  necessary  to  keep  it  in  place  when  ad- 
justed. At  least  nine  safety  pins  should  be  allowed  for  each 
bandage. 

T  Bandages 

These  are  made  of  muslin,  cotton  flannel,  or  domet  flan- 
nel. The  belt  must  be  made  double,  2^  to  3^  inches  wide 
and  54  inches  long.  The  edges  are  turned  in  and  stitched 
all  around.  The  T  is  made  7  inches  wide  and  40  inches 
long,  and  if  made  of  muslin  must  be  double  and  have  raw 
edges  turned  in  and  stitched  all  around.  If  made  of  cotton 
flannel  or  domet  flannel,  it  may  be  single  and  have  the  edges 
overcast.  The  T  is  placed  at  the  center  of  the  belt  between 
the  folds  and  reaches  to  the  top  of  belt,  being  firmly  stitched 
in  place  there.  Tear  the  T  in  two  equal  widths  from  the 
bottom  to  within  10  inches  of  the  bottom  of  the  belt.  If 
the  T  is  of  a  single  thickness,  a  strip  of  cloth  must  be 
stitched  across  at  this  point  to  act  as  a  reenforcement  to 
keep  it  fromi  tearing  the  remainder  of  the  way.    If  it  is  of 


30 


STANDARD    SURGICAL   DRESSINGS 


double  thickness,  the  torn  edges  are  turned  in  and  stitched 
all  around.  Three  safety  pins  are  used  in  this  bandage — 
one  in  the  belt  and  one  for  each  strap  of  the  T. 


54 


CO 


T    BANDAGE 

Head  Bandage,  or  Four-Tailed  Bandage 

This  is  made  of  heavy-weight,  unbleached  muslin.  It  is 
cut  8  inches  wide  and  36  inches  long,  of  single  thickness 
of  material.  From  the  middle  of  each  end  it  is  cut  in  a 
distance  of  12  inches  to  form  the  tails  which  tie  around  the 
head. 

36" 


Head  Bandage 


STANDARD    SURGICAL   DRESSINGS 


31 


Scultetus,  or  Many-Tailed  Bandages 

These  may  be  made  of  heavy  musHn,  cotton  flannel,  or 
domet  flannel.  They  are  used  to  keep  dressings  in  place  and 
to  induce  pressure.  They  can  be  adjusted  more  easily  and 
comfortably  than  the  straight  abdominal  bandages. 

To  make  a  scultetus  bandage,  six  strips  4  inches  wide 
and  54  inches  long,  and  two  cross  strips  3  inches  wide  and 
45  inches  long,  are  required.  The  raw  edges  should  be  fin- 
ished with  a  narrow,  flat  hem.  Lay  the  long  strips  on  the 
table,  like  clapboards  on  a  house,  overlapping  about  i^ 
inches,  forming  a  bandage  measuring  15  inches  from  top  to 
bottom,  and  pin  in  place.  Then  place  the  cross  strips  on 
the  back  of  the  bandage,  with  their  ends  even  with  the  top, 
but  8  inches  apart  at  the  top  and  5  inches  apart  at  the  bot- 
tom. All  the  strips  are  pinned  or  basted  in  place,  and  then 
firmly  stitched  around  each  cross  strip  and  once  through  the 
center  of  the  bandage  between  the  cross  strips.  Eight  safety 
pins  are  used  in  this  bandage,  one  in  the  end  of  each  strip. 


10 


54" 


-V5 


SCULTETUS    BANDAGE 


2,2  STAXDARD    SURGICAL    DRESSINGS 

Sheet  Wadding  or  Cotton  Wadding  Bandages 

These  are  made  from  sheet  wadding  and  are  cut  from 
3  to  5  inches  wide  and  3  yards  long.  They  are  used  over  a 
gauze  dressing  before  the  regular  muslin  bandage  is  ap- 
plied. Being  non-absorbent,  they  protect  the  muslin  band- 
age from  the  stains  of  discharge  which  would  otherwise 
drain  through  from  the  wound.  Sheet  wadding  bandages 
are  also  used  on  swollen  limbs  before  the  muslin  bandage 
is  applied.  Because  of  their  softness  they  act  as  a  padding 
and  prevent  cutting  and  chafing,  which  might  occur  if  the 
muslin  bandage  were  applied  directly  to  the  limb.  Sheet 
wadding  bandages  are  also  used  on  limbs  before  plaster 
casts  are  applied  because  of  their  usefulness  as  a  padding. 


CHAPTER  V 

How  to  Make  Dressings  into  Packages 

All  dressings  that  come  in  direct  contact  with  wounds 
must  be  steriHzed  before  they  are  used.  To  get  them  in 
correct  shape  for  steriHzation,  they  must  be  made  into  pack- 
ages with  a  heavy,  closely-woven  muslin  cloth  for  a  cover. 
Filter  paper  can  also  be  used  as  a  cover  for  the  packages, 
n  the  packages  are  wrapped  too  tightly  it  interferes  with 
the  process  of  sterilization,  while  if  they  are  wrapped  too 
loosely,  the  dressings  lose  their  shape  and  occupy  more 
space  in  packing.  The  number  of  dressings  in  the  package 
must  conform  to  the  custom  of  the  country  in  which  they 
will  be  used.  It  is  of  the  greatest  importance  to  have  the 
exact  number  in  each  package:  if  ten  is  the  required  num- 
ber, to  have  ten  —  no  more,  no  less. 

The  packages  should,  as  far  as  possible,  be  of  uniform 
shape  and  size.  This  is  particularly  desirable  if  the  dress- 
ings are  to  be  transported,  and  will  greatly  facilitate  the 
process  of  packing,  both  as  to  time  and  space.  The  number 
and  kind  of  dressings  should  be  plainly  stamped  on  the  out- 
side of  each  package. 

Sponge  No.  1 

In  counting  the  number  of  sponges  for  a  package,  place 
each  sponge  separately,  one  on  top  of  the  other,  with  the 
"hinges"  all  turning  one  way.  (A  second  person  should 
always  verify  this  counting.)  A  piece  of  heavy,  unbleached 
nmslin  measuring  12  x  12  inches  square  is  used  as  a  cover- 
ing for  this  package. 

33 


34 


STANDARD    SURGICAL   DRESSINGS 


Place  the  pile  of  sponges  diagonally  on  one  corner  of 
this  cover,  leaving  just  enough  muslin  on  the  corner  towards 


STANDARD    SURGICAL   DRESSINGS 


35 


you  to  draw  up  over  the  edge  and  top  of  the  pile.  Hold  the 
parcel  firmly  and  turn  towards  the  center  of  the  cover,  be- 
ing careful  to  keep  the  sponges  in  shape  and  free  from 
wrinkles.  Draw  the  ends  of  the  cover  up  neatly  over  the 
sides  of  the  package,  and  hold  in  place  while  the  remaining 
corner  of  the  cover  is  folded  up  and  tucked  into  the  pocket 
formed  by  the  folding  up  of  the  ends.  This  is  held  in  place 
by  two  pins,  or  the  package  may  be  tied  with  fine,  strong 
cord. 


Sponge  No.  2 

These  sponges  or  wipes  are  small,  and  usually  twenty- 
four  are  placed  in  a  package.  For  the  sponge  measuring 
4x4  inches  square  use  a  cover  measuring  14  x  14  inches 
square.  For  the  sponge  measuring  2x2  inches  square  use 
a  cover  measuring  9x9  inches  square.  Count  the  sponges 
carefully  by  placing  each  separately,  one  on  top  of  the 
other,  then  place  the  pile  diagonally  and  in  the  center  of  the 
cover.  Fold  the  corner  of  the  cover  nearest  you  neatly  up 
over  the  edge  of  the  sponges,  then  fold  up  the  ends  of  the 


36  STANDARD    SURGICAL    DRESSINGS 

cover,  holding  them  securely  in  place  while  the  remaining 
end  of  the  cover  is  drawn  up  and  tucked  into  the  pocket 
formed  by  the  folding  up  of  the  two  ends.  This  is  held  in 
place  by  two  pins,  or  the  package  may  be  tied. 

Compresses 

The  number  of  compresses  used  in  a  package  is  usually 
twenty  or  twenty- four.  For  a  compress  measuring  3x3 
inches,  a  cover  measuring  10  x  10  inches  is  required.  For  a 
compress  measuring  5x5  inches,  a  cover  measuring  14  x  14 
inches  is  required.  For  a  compress  measuring  9x9  inches, 
a  cover  measuring  20  x  20  inches  is  required. 

To  make  a  package  of  compresses,  place  the  pile  con- 
taining the  exact  number  diagonally  and  in  the  center  of  the 
cover.  Fold  the  corner  of  the  cover  nearest  you  neatly  up 
over  the  side  of  the  pile,  then  fold  up  the  ends  of  the  cover, 
holding  them  securely  in  place.  Then  fold  up  the  remain- 
ing end  of  the  cover  and  tuck  into  the  pocket  formed  by  the 
folding  up  of  the  ends.  This  is  held  in  place  by  two  pins, 
or  the  package  may  be  tied. 

Wicks  or  Drains 

Each  drain,  after  having  been  rolled  and  tied,  is  made 
into  a  separate  package.  For  a  drain  measuring  ^  x  36 
inches,  a  cover  measuring  3^  x  3-i  inches  is  required.  For 
a  drain  measuring  i  x  72  inches,  a  cover  measuring  5x5 
inches  is  required.  For  a  drain  measuring  2  x  72  inches,  a 
cover  measuring  6x6  inches  is  rec|uired.  For  a  drain 
measuring  3  x  72  inches,  a  cover  measuring  J  :^y  inches 
is  required.  Place  the  drain  in  the  center  of  the  cover,  fold 
up  the  end  of  the  cover  nearest  you,  then  fold  up  the  sides 
of  the  cover,  holding  them  securely  in  place.    Draw  up  the 


STANDARD    SURGICAL    DRESSINGS  37 

remaining-  end  of  the  cover  and  tuck  into  the  pocket  formed 
by  the  folding  up  of  the  sides.  This  is  held  in  place  b}^  two 
pins. 

Meter  Gauze 

Three  of  these  dressings  are  usually  placed  in  each 
package,  and  a  cover  measuring  14  x  14  inches  is  required. 
Place  the  pile  of  dressings  diagonally  and  in  the  center  of 
the  cover.  Fold  the  end  of  the  cover  nearest  you  neatly  up 
over  the  side  of  the  dressings.  Then  fold  up  the  ends  of  the 
cover,  holding  them  securely  in  place.  Fold  up  the  remain- 
ing end  of  the  cover  and  tuck  into  the  pocket  formed  by 
the  folding  over  of  the  ends.  This  may  be  held  in  place  by 
two  pins,  or  the  package  may  be  tied. 

Cut  Gauze 

In  each  package  of  gauze  the  number  of  pieces  varies' 
according  to  their  size.  The  uniform  size  of  the  packages  is 
more  important  in  this  dressing  than  the  rrumber  of  pieces 
they  contain.  Usually  not  more  than  fifty  pieces  would  be 
used.  The  pieces  of  gauze  are  folded  approximately  to 
measure  4x4  inches,  and  a  cover  measuring  10  x  10  inches 
is  required.  The  dressings  are  placed  diagonally  in  the  cen- 
ter of  the  cover,  and  the  package  is  finished  in  the  same  way 
as  the  package  of  compresses. 

Cotton,  Oakum,  and  Sphagnum  Moss  Pads 

Each  pad  is  made  in  a  separate  package,  and  a  cover 
measuring  12x12  inches  to  12  x  14  inches  is  required,  ac- 
cording to  the  thickness  of  the  pad.  Roll  the  pad  snugly 
from  the  open  end,  then  wrap  in  the  cover  (leaving  an  equal 
length    of    cover   overlapping   on    each   end    of    pad),    and 


38  STANDARD    SURGICAL   DRESSINGS 

secure  with  one  pin  placed  in  the  middle  of  the  fold.  Then 
draw  the  ends  of  the  cover  neatly  up  over  the  ends  of  the 
pad.  holding-  each  in  place  with  two  pins. 


THE    COMPLETED    PAD 


Gauze  Laparotomy  Pads  with  Tapes 

Six  of  these  dressings  are  placed  in  each  package,  and 
for  pads  measuring  6x6  inches,  a  cover  measuring  12  x  12 
inches  is  required.  For  pads  measuring  4x16  inches,  a 
cover  measuring  14  x  14  inches  is  required.  For  pads  meas- 
uring 12x12  inches,  a  cover  measuring  18x18  inches  is 
required.  The  pile  of  dressings  is  placed  diagonally  in  the 
center  of  the  cover,  and  the  package  is  finished  in  the  same 
way  as  the  package  of  compresses. 

Gauze  Rolls 

From  two  to  six  of  these  dressings  are  placed  in  each 
package.  For  two  rolls  measuring  three  yards  long,  a  cover 
measuring  14x14  inches  is  required.  For  six  rolls  meas- 
uring three  yards  long,  a  cover  measuring  18  x  18  inches  is 
required.  For  six  rolls  measuring  one  yard  long,  a  cover 
measuring  12  x  12  inches  is  required.  The  dressings  are 
placed  diagonally  in  the  center  of  the  cover,  and  the  package 
is  finished  in  the  same  way  as  the  package  of  compresses. 


CHAPTER  VI 

How  and  Why  Surgical  Dressings  are  Sterilized 

Sterilization  means  the  complete  destruction  of  all 
life,  either  within  or  upon  the  substance  sterilized.  The 
process  is  accomplished  either  by  chemical  agents  or  by  heat. 
Bacteria  are  found  everywhere,  and  are  the  smallest  and 
simplest  form  of  microscopic  life.  There  are  two  great 
divisions  of  bacteria — saprophytes  and  parasites.  The 
former  feed  on  dead  tissue,  and  are  therefore  the  friends 
of  animal  life.  Parasites  feed  on  living  tissue,  and  are 
therefore  deadly  foes  to  animal  life. 

Certain  bacteria  enter  a  stage  known  as  spore  forma- 
tion. The  spore  forms  as  a  seed  in  the  bacillus,  and  being 
of  a  hard,  dense  structure,  offers  great  resistance  to  heat 
and  to  disinfectants.  Under  certain  conditions  which  would 
kill  bacteria  the  spores  are  unharmed,  and  remain  dormant 
until  the  right  conditions  are  present.  Then  the  bacteria  go 
on  to  multiply  as  before.  They  flourish  and  grow  rapidly 
in  damp,  dark,  warm  places. 

The  history  of  bacteria  dates  back  to  the  seventeenth 
century,  but  it  was  not  until  the  year  1875  that  disinfectants 
began  to  be  used  in  surgery.  The  first  disinfectant  to  be 
used  was  carbolic  acid  by  Lord  Lister,  an  EngHsh  surgeon. 
Since  that  time  rapid  strides  have  been  made  in  the  use  of 
substances  either  to  destroy  germs  or  to  retard  their  growth. 

The  best  method  of  sterilizing  is  by  steam  heat  under 
pressure,  using  the  autoclave  sterilizer,  A  temperature  of 
250°  with  fifteen  pounds  pressure  for  one  hour,  and 
repeated  the  following  day,  will  insure  the  complete  destruc- 

39 


40  STANDARD    SURGICAL   DRESSINGS 

tion  of  both  germs  and  their  spores.  Dry  heat  at  a  tempera- 
ture of  338°  for  one  hour  is  also  sufficient  to  destroy  spores. 
Among  our  best  disinfectants  are  alcohol,  carbolic  acid,  bi 
chloride  of  mercury,  and  formalin. 


CHAPTER  VII 

Preparation  of  Dressings  for  Storage  and  Shipment 

Dressings  that  are  to  be  used  within  a  week  after  they 
are  made,  after  steriHzation  may  be  placed  in  glass  jars  with 
covers,  or  arranged  neatly  on  shelves  where  they  will  be 
secure  from  dust  and  dampness.  If  they  are  to  be  stored  for 
a  longer  period,  much  more  care  must  be  taken  in  the  pack- 
ing in  order  to  maintain  their  sterility.  The  best  containers 
for  packing  are  tin  cans  which,  after  being  filled,  are  her- 
metically sealed.  Dressings  packed  in  this  way  have  been 
found  to  have  remained  sterile  after  several  months.  A  can 
measuring  nine  inches  wide,  nine  inches  long,  and  thirteen 
inches  deep  is  a  convenient  size. 

The  sterilized  packages  are  assembled  in  bundles  to  fit 
the  can,  allowing  two  or  three  bundles  for  each  can.  These 
bundles  are  securely  tied  with  cord  or  tape  to  keep  them  in 
shape.  In  forming  the  bundles,  care  must  be  taken  not  to 
exert  too  much  pressure,  because  pressure  will  destroy  the 
elasticity  of  gauze,  which  is  its  chief  property  of  absorb- 
ency.  Each  bundle  is  wrapped  in  waxed  paper  and  then  in 
a  second  covering  of  heavy  brown  paper,  and  tied  with 
white  cord  or  tape.  The  bundles  should  be  placed  in  the 
can  so  that  the  paper  coverings  may  be  opened  from  the  top. 
The  dressings  may  then  be  taken  as  needed  from  the  bundle, 
without  removing  it  from  the  can.  The  paper  coverings 
form  a  receptacle  for  the  packages  of  sterile  dressings ; 
and  after  the  number  needed  for  immediate  use  are  re- 
moved, the  bundle  should  be  closed  again.  Packages  of 
dressings  after  they  are  sterilized  should  be  handled  as  lit- 

41 


42  STANDARD    SURGICAL   DRESSINGS 

tie  as  possible,  in  order  to  keep  them  sterile.  An  invoice  of 
the  entire  contents  of  the  can  should  be  placed  inside  before 
the  cover  is  adjusted.  An  invoice  of  its  contents  should  also 
be  pasted  on  the  outside  of  the  can.  A  strip  of  heavy  brown 
paper  should  be  pasted  along  the  seam  of  the  cover,  and 
after  it  is  thoroughly  dry,  a  coating  of  shellac  should  be  ap- 
plied over  the  paper  to  make  it  waterproof.  These  cans  may 
be  packed  in  heavy,  wooden  packing  cases  when  required 
for  shipment. 

For  the  packing  of  dressings  that  will  be  used  non- 
sterile,  or  for  those  that  are  to  be  sterilized  after  shipment, 
heavy,  wooden  packing  cases  lined  with  waterproof  paper 
should  be  used.  A  case  measuring  twelve  inches  wide, 
thirty-three  inches  long,  and  ten  inches  deep  is  a  convem^ent 
size  for  general  packing.  The  waterproof  paper  lining 
should  be  held  in  place  with  thumb  tacks,  and  should  be  cut 
long  enough  to  allow  for  folding  over  the  top  of  the  dress- 
ings before  the  cover  of  the  case  is  adjusted.  None  of  the 
dressings  that  will  be  used  non-sterile  need  to  be  placed  in 
a  cover,  but  for  the  sake  of  convenience  in  packing,  such 
articles  as  abdominal  bandages  and  triangular  bandages 
may  be  tied  together  in  packages  with  cord  or  tape. 


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